In August, Luisel Ramos of Uruguay, only 22, died of a heart attack moments after stepping off a catwalk in Montevideo. She had reportedly been living on lettuce and diet drinks. In response, models auditioning for Madrid Fashion Week are now examined by doctors and those with a body mass index (BMI) that is below 18 are off the runway. According to the World Health Organization a BMI less than 18.5 is considered underweight, 17.5 indicates anorexia, and a BMI nearing 15 is on the point of starvation. When she died, Ms Reston’s BMI was just 13.4. The BMI is the ratio of a person’s height to their weight.

Now a second model has died from being too thin – Ana Carolina Reston, a well-known Brazilian model who worked for Giorgio Armani, died of kidney failure this week (Tuesday, 14 Nov 2006) at the age of 21, one day before she was to fly to Paris for a photo shoot. She was 5 feet 7 inches tall but only 88 pounds. The model reportedly ate little else than tomatoes and apples. Reston had been recently hospitalized because of a generalized infection due to her weakened condition, and had been in the hospital three weeks when she died. She had been a model since 13 after winning a local beauty contest in her hometown of Jundiai, on the outskirts of Sao Paulo. She had spent the last eight years working as a model for several agencies, including L’Equipe and Armani, and did jobs in China, Turkey, Mexico and Japan, local media said.

Ana’s mother, Miriam Reston, spoke to the O Globo newspaper in Brazil, saying that Ana had been trying to help her family with the money she made as a model, but to “Take care for your children because their loss is irreparable. “Nothing can make the pain go away. No money in the world is worth the life of your child, not even the most famous (fashion) brand is worth this. Her boyfriend, Bruno Setti, 19, is also a model. Bruno’s mother Viviane spoke out and said, “Ana’s death should serve as a wake-up call to modeling agencies about the danger of anorexia. There’s nothing glamorous about an ending like hers.”
Dani Grimaldi, Reston’s cousin, told Estado de Sao Paulo that Ana Carolina also suffered from bulimia. “Fifteen minutes after eating she would lock herself in the bathroom and turn on the shower so no one could hear her vomiting,” he said.

Ana had seen specialists about her eating disorder, relatives say, but had resisted admitting that she was ill. “She had no resistance and the medication had no effect because of her extreme weakness,” her aunt, Mirthes Reston, said.

Another cousin, Geise Strauss, 30, who lived with her, said: “She didn’t like eating what we ate. When she did eat, she ate very little and recently she’d go to the bathroom and make herself sick as soon as as she left the table. She liked apples and she adored tomatoes as well but that was about it.”

Lica Kohirausch, owner of agency for whom Ana worked, said: “We brought Ana back to Brazil after she did a catalogue for Giorgio Armani and a representative rang me to say she was too thin. It worried me coming from a professional used to dealing with models and I acted immediately, but I didn’t see any physical signs of anorexia on her return.

A spokesman for L’Equipe amplified by saying, “We don’t force our professionals to be ‘very thin.’ Those who have a naturally thin biotype work in fashion and those who haven’t are addressed to advertising. After [she] had to be admitted in the hospital, she was frequently visited by an employee from the agency. All medical staff responsible for her was extremely worried, because she complained from pain in the kidneys and had a profile of generalized infection.
“L’Equipe would like to reinforce that its philosophy has always included the concern about the professionals’ health, including their diet and physical activities. We are deeply sorry about what happened to Ana Carolina Reston. Even in these dark times, we have never stopped helping the model and her family.”

The issue of ultra-thin “zero” models (who wear size zero) has been a big topic of debate. While Spain has taken sharp action, the French have taken a different attitude than their southern neighbors – the head of the French Couture Federation, Didier Grumbach, insists anorexia is a “social problem” that should be controlled through “information” not “regulation.”

“To say that we should regulate just one profession among many to avoid young girls getting thin, when everything in our society encourages them to do so, is unreasonable,” Grumbach said.

His words are echoed by Chanel, whose spokesman said that “the fashion world is not responsible for anorexia. You can’t solve a global problem by regulating one profession. That’s an inappropriate response to a serious problem. Fashion is a reflection of changes in society. It’s not the cause,” he argued. “People shouldn’t try and turn something that is a worldwide health problem into a fashion world drama.”

Achilleas Constantinou, a leading member of the British Fashion Council, was one of the first to call for a ban on super-skinny models.

This week, Armani entered the fray to support ejecting super-skinny models from all the main fashion shows. “I have never liked thin girls and I have never made them go on the catwalk,” he asserted.

Karl Lagerfeld sees it differently – “What I really didn’t like was that certain fashion sizes were made bigger. What I created was fashion for slim, slender people”

Famously skinny model Twiggy responded that “Everyone is not meant to be skinny. It’s a tricky area. The designer likes to design for slim models. It’s how they feel their clothes look the best”

And the fight over “zero sized” fashions may only intensify this fall. In the U.S., Banana Republic and Nicole Miller will introduce “sub-zero” sized fashions for women this fall, taking skinny sizes to a new low.

[...] Kate Winslet and Billie Piper last week slammed the skinny look, saying it skewed the perceptions of young women and was dangerous. They were then joined by Cameron Diaz, who said much the same on the Parkinson talk show. The controversy has been a hot topic since the death last month of Ana Carolina Reston, 21, a Brazilian model who suffered from anorexia, and the August death of Uruguayan model Luisel Ramos, 22, who died of heart failure after not eating for several days. The shrinking figures of Nicole Richie and Kate Bosworth have also lately been the subject of intense debate. [...]

[...] However, the deaths drew widespread media attention in Latin America, where the fashion industry’s treatment of young women has been the subject of debate since anorexia was blamed for the deaths of model Ana Carolina Reston and three other Brazilian women in December. The world fashion industry has taken some action against anorexia and the vogue for stick-thin models, with shows in Spain and Italy banning ultra-thin models. In Madrid on Sunday, organizers of Spain’s top annual fashion show rejected five of 69 models, saying they were underweight. [...]